Anxiety disorders are the most common psychiatric disorders in North America. They are extremely debilitating for the suffering individual, disrupting one’s ability to engage in a full, functional life. The consequences of anxiety are profound emotional, occupational and social impairments. When evaluating patients with symptoms of anxiety, a thorough work-up should be done so that organic causes of anxiety are ruled-out. When the work-up does not reveal an organic cause, a psychiatric diagnosis needs to be considered. Anxiety disorders are classified into various psychiatric categories.
Adequate treatments should be provided to mitigate the suffering of these patients. One of the most effective ways to accomplish this is through the use of the amide of niacin (nicotinic acid) known as niacinamide (nicotinamide). This B-vitamin has remarkable therapeutic benefits for those suffering from anxiety. In a recent report by this author, a review of the literature was undertaken to determine the biological mechanism for niacinamide’s anti-anxiety effects. It appears that niacinamide has therapeutic effects comparable to the benzodiazepines, a class of medications commonly used for the treatment of anxiety disorders. Niacinamide’s therapeutic effects are likely not related to it acting as a ligand for the benzodiazepine receptor, even though it acts centrally and might have a weak binding affinity for the benzodiazepine receptor. Both the benzodiazepines and niacinamide exerts similar anti-anxiety effects through the modulation of neurotransmitters commonly unbalanced in anxiety.
Glycine is a nonessential (or neutral) amino acid that has profound anti-anxiety properties. Receptors for glycine are found in the vertebrate CNS, spinal cord and brain stem areas, and are equally distributed throughout mammalian tissues. The most unique aspect of glycine’s mechanism of action has to do with its presumed antagonism of norepinephrine (NE). When an individual experiences anxiety or panic, NE is released and creates feelings of anxiety and panic. Glycine antagonizes the release of NE, thus mitigating anxiety and panic and feelings of over-arousal.
The final nutrient to be discussed is vitamin B12. It is well known that regular use of vitamin B12 helps those patients having had a documented deficiency. However, there are many other patients who seem to benefit psychologically from regular vitamin B12 injections despite the absence of diseases and diagnostic evidence of vitamin B12 deficiency. What is the mechanism that can account for the anti-anxiety benefits of injectable vitamin B12 (cyanocobalamin or hydroxocobalamin)? In a study involving forty-nine patients with organic mental disorders, deficient CSF levels of vitamin B-12 (<5 pg/ml) were found in thirty patients. When the serum levels of vitamin B-12 were tested, normal values (200-800 pg/ml) were found in forty-five of them, indicating a marked difference between both compartments. A group of ten patients were also given injectable hydroxocobalamin at a dose of 1000 mcg twice weekly for six weeks. This group was compared against a group of two patients given 0.1 mg of oral cyanocobalamin three times daily for six weeks. The group given the injections achieved a much greater increase in their CSF levels of vitamin B12. Given that serum levels of vitamin B-12 can be normal yet deficient in the CSF, patients responding to regular IM injections of vitamin B12 might have an improvement in their anxiety due to marked (supraphysiological) increases in their CSF levels, or from the correction of deficient CSF levels. The best way to achieve high CSF levels of vitamin B12 is through twice weekly injections. When trying to control symptoms of anxiety, it might be necessary for patients to receive regular injections of vitamin B12. In addition to the therapeutic use of certain nutrients, caffeine and alcohol should be eliminated in all patients with anxiety disorders. Caffeine is a stimulant and can sometimes be the underlying cause of a patient's anxiety. Alcohol has been demonstrated to increase the lactate-to-pyruvate ratio, which can precipitate anxiety. Alcohol has also been shown under double-blind conditions to increase anxiety. More research and rigorous controlled trials are needed to properly evaluate the therapeutic effectiveness, safety and mechanisms of action of niacinamide, glycine, and vitamin B12. In light of the positive results accomplished from regularly using these nutrients in my private naturopathic practice, I believe they are indicated for the management of anxiety. These agents might, in fact, be more effective than current contemporary medications for the treatment of anxiety disorders since they produce minimal side effects and they have a safety profile unmatched by most conventional (contemporary) medications that are currently in use.